Falls in older people

‘A fall is an event whereby an individual comes to rest on the ground or another lower level with or without loss of consciousness. The risk of falling can be addressed through a targeted multifactorial intervention against a background of general diagnosis and management of the causes and recognised risk factors’ (NICE 2013)

Older people who report more than one fall in the last 12 months or have difficulty with balance or walking or present for medical attention following a fall will benefit from a multifactorial falls risk assessment.(NICE 2013)

If an older person has fallen they should initially be screened for acute illness including a falls blood screen which involves thyroid, full blood count, electrolytes, liver function tests, calcium, glucose, vitamin B12 and folate.

If a falls risk assessment has already been completed in the last 12 months this should be reviewed for changes and outcomes before making further referrals.

Multi-factorial falls risk assessment and intervention is provided by all Bristol Community Health services in day to day contact with older people using:

  • A standardised assessment template which includes bone health and meets NICE guidance.
  • A pathway which signposts to more advanced assessment, or the frailty pathway.
  • The provision of individual, evidence based, strength and balance exercises as needed.

For health professionals

From the 1st July 2018, if Bristol Community Health staff have considered a patient’s risk of falls, this will be listed in the BCH EMIS summary page under active problems as ‘falls risk assessment complete’, together with the date of the assessment. The detail of the falls risk assessment template will be in the consultation for that date.  The problem code will also appear in the Connecting Care record.

Referrals for falls risk assessment and interventions

Specialist medical assessment provided by hospital trusts

Patients with:

  • suspected syncope or with unexplained symptoms of dizziness
  • recurrent falls who have had a multi-factorial risk assessment and no cause has been identified by community assessment
  • recurrent falls in spite of interventions to manage the risk
    are appropriate for referral to a hospital care of the elderly clinic for specialist medical assessment.

Advanced comprehensive assessment

Patients with complex backgrounds, including frailty, should be considered for advanced comprehensive assessment, which can be delivered by advanced practitioners as below:

  • Community nursing team – for housebound patients with a nursing need.
  • Community therapy team – if patients have an identified therapy need.
  • Falls Specialist Nurse, for non urgent comprehensive assessment of complex patients at risk of recurrent falls. The nurse will identify any need for further investigation and use shared decision making to produce an action plan for risk reduction with the patient and referral on to other services as necessary.

Referrals to the Falls Specialist Nurse are accepted from health professionals by letter addressed to:

Falls Specialist Nurse
Knowle Clinic
Broadfield Road
Tel: 0117 9190290
Fax: 0117 9190296

Please indicate what you hope to achieve from the assessment and ensure that the routine falls blood tests (thyroid, full blood count, electrolytes, liver function tests, calcium, glucose, vitamin B12 and folate) have been completed.

Referrals to the Falls Specialist Nurse are not accepted directly from care homes.

For further information contact Ruth Cowell, Falls Specialist Nurse
Mobile: 07767 220 976

Multi-factorial falls risk assessment

This includes a focused assessment of history, function, environment and physical presentation. The following services are in day-to-day contact with older people and will identify patients who need a multi-factorial falls risk assessment and also take appropriate referrals.

Urgent Care Service – for falls assessment associated with acute medical illness admission avoidance.

Community nursing teams – for housebound patients with a nursing need.

Community therapy – for assessment focused around mobility, function and environment.

Musculoskeletal outpatient physiotherapy – for post fracture management and musculoskeletal conditions for patients who can be seen in an outpatient clinic .

Useful resources

Staying steady classes by Bristol City Council.

The Age UK website provides helpful information for patients regarding falls prevention.

Lying and standing blood pressure guidance